Why should people without diabetes monitor glucose levels?

Only 12% of the U.S. population is considered metabolically healthy. Today, more than 120 million Americans have prediabetes or diabetes, and 84% of people with prediabetes don’t even know they have it. What’s more, 9 of the 10 leading causes of death in the U.S. are strongly related to metabolic dysfunction or are exacerbated by poor glucose control. In short, too much glucose can have serious consequences for anyone.

Fortunately, the beauty of striving for better metabolic fitness is that much of it is in our control.

Maintaining stable glucose ranges can improve energy, endurance, memory, mood, and cognitive performance. Levels’ goal is to help you improve metabolic fitness by alerting you to foods and lifestyle choices that negatively impact glucose levels, so you can make healthier, more informed decisions.

Read more about Levels’ theory of behavior change here.

Can’t I just look at a glycemic index to see how foods will affect me?

Glycemic index (GI) indicates how quickly your body processes the carbohydrates in a particular food, and can be a useful guide to what might cause a glucose spike. For example, potatoes have a high GI, so they can cause a spike even without added sugar.

But how we each respond to food goes beyond the macronutrient composition of the food itself. You might respond well to bananas and have a big spike when you eat rice, while someone else may have the opposite response. Individual differences, such as the composition of our gut microbiome, how well we sleep, exposure to stress, physical activity, and our genetics can all contribute to those unique reactions. The more you know about how your body responds, the easier it becomes to make healthy choices.

Why does Levels measure glucose and not insulin?

Insulin is a hormone released by the pancreas that allows  glucose to move from our blood into our cells, where it can be stored or converted to energy. When glucose is too high too frequently, we produce too much insulin. Over time, that can lead to insulin resistance, a condition associated with serious chronic disorders including heart disease, cancer, stroke, dementia, and infertility.

However, insulin cannot be tested continuously at home. Continuous glucose monitors (CGM) makes glucose simple to measure yourself, and since the body releases insulin in response to glucose elevation in the blood, CGMs can help coach people to eat for fewer glucose spikes and therefore minimize excess insulin

What is a healthy range for glucose levels?

The International Diabetes Federation recommends that for people without diabetes, glucose levels should remain below 140mg/dL after meals and return to pre-meal levels within 2–3 hours. However, there are no standardized, universally accepted criteria for what “normal” or “optimal” 24-hour glucose values are for non-diabetic people wearing CGMs. 

Levels recommends maintaining glucose levels between 72–110 mg/dL, limiting post-meal glucose rises to no more than 30 mg/dL from pre-meal levels, and maintaining an average glucose of 100 mg/dL or lower. We based these guidelines on observed blood-glucose levels in several studies of healthy, non-diabetic people wearing CGMs. Remember, your optimal glucose levels are specific to you—talk to your healthcare provider about your target range.

Read more about recommended glucose levels here. 

Captured at on Nov 09, 2020 by Stacie Flinner Photography.

THINGS THAT AFFECT BLOOD SUGAR

What are some diet suggestions to keep my glucose low and stable?

Many aspects of our diet impact our metabolic response, including the amount of carbohydrates in a food, whether carbs are paired with fat, protein, or fiber, the body’s micronutrient status (vitamins and minerals are key metabolic factors), microbiome composition, and exposure to metabolic disrupting environmental chemicals that can be present in our food and drinks.

There are also many different diets that can support metabolically healthy eating, and a core Levels principle is recognizing that each of us reacts differently to different foods.

TLDR: Eat a thoughtful, clean, unrefined diet filled with fiber, protein, healthy fats, and micronutrients to support metabolic health from multiple angles.

• Don’t eat carbohydrates alone. Pair carbs with healthy protein, fats, and fiber. If you eat an apple, pair it with a nut butter or put it in a chia seed pudding (high fiber and healthy fats). If you have a sweet potato, add tahini, olive oil, flax seeds or nuts, plus some protein. 
• A diet that’s least likely to cause sharp glucose spikes is one that emphasizes whole, unprocessed foods. Foods made in a factory or that come in a package are likely to be refined, so are more likely to generate a glucose spike, be nutrient poor, and have additives that can damage our metabolism and microbiome.
• Eat a lot of low-carbohydrate vegetables (i.e. greens, broccoli, cauliflower, zucchini, Brussels sprouts), which are filled with micronutrients and are unlikely to have much impact on glucose levels. 
• Many research studies suggest that including fiber and protein-rich foods like beans, legumes (i.e., lentils), nuts, and seeds support stable glucose levels.  
• Fats in their whole-food form like nuts, seeds, avocado, coconut, and olives have little impact on glucose and may buffer the effect of of carbohydrates.
• Try small amounts of whole grains and low-sugar fruits to see how they affect your glucose, and try pairing them with fat, protein, and fiber to minimize any spikes.
• If you eat animal products, focus on wild-caught, small fish like sardines, anchovies, and salmon, and choose organic, grass-fed, antibiotic- and hormone-free beef, lamb, game meats, or eggs. These will have more omega-3 fats, which support metabolic health. 
• Avoid refined sugar of any kind. Beware: There are dozens of hidden types in things ranging from ketchup to bread to salad dressings to peanut butter. 
• Try to buy organic as much as possible, as these products tend to have a higher nutrient density and less pesticides, both of which can have an impact on metabolic processes. 
• Focus on healthy food swaps that allow you to have your favorite foods without the spike. Things like NuPasta, which is made from high-fiber konjac root, instead of white-flour pasta, or cauliflower rice instead of rice. 

If I just avoid sugary foods, can I avoid glucose spikes?

First, it’s important to know that hidden sugars go by a lot of names, including beet sugar and agave. Second, it’s not just added sugars: Anything made with refined grains or flour, like white bread, tortillas, crackers, or bagels; refined fruits like juice; and starchy foods like potatoes, sweet potatoes, instant oatmeal, or squash, can all spike your glucose, particularly when eaten without fat, protein, or fiber.

Our bodies convert all carbohydrates into glucose, regardless of whether they come from oatmeal, pasta, fruit, or a donut. A benefit of using a CGM is that you can learn to properly pair, time, and sequence foods effectively, and identify foods that cause a particularly high glucose spike for you, so that you can avoid or modulate them.

Read more about strategies for lowering your glucose levels. 

What about exercise and glucose?

Regular exercise has several benefits for metabolic fitness. It can help train our bodies to more efficiently switch from using glucose for energy to burning fat; we call that metabolic flexibility. Second, muscle contraction can enable our muscles to take up glucose from the bloodstream without additional insulin. Regular exercise can also increase the amount of fat we burn between meals and our number of cellular mitochondria (which process fat and glucose to make energy). 

And you don’t have to exercise profusely to realize these benefits. Multiple studies show that moderate activity for just 30 minutes, three times per week can improve insulin resistance and glycemic control. Research has also found that many short bouts of movement throughout the day can be more beneficial than one longer workout, so aim to be more active more frequently, even if it’s for just a few minutes. 

Read more about glucose and exercise here.

So then why does my glucose spike while working out?

Some people see a rise in blood glucose levels during intense exercise. That’s because workouts that push your body above around 80% VO2max stimulate the liver to release more of its stored glucose, and if that exceeds what the muscles need for the workout, you may see higher circulating glucose.

This isn’t something to worry about, however. High-intensity training actually improves both fasting glucose and insulin sensitivity in as little as two weeks. Additionally, glucose spikes during exercise are the result of a different chain of physiological processes compared to the body releasing insulin to metabolize a meal. 

For easy-to-moderate efforts like walking, jogging or riding a bike, the body is not going to be stimulated to quickly release glucose from the liver, and will mostly rely on circulating glucose and fat for energy. So with low-intensity exercise (around 60% VO2max or less), people typically see glucose decline slightly or stay stable. 

What do sleep and stress have to do with glucose levels?

When we experience stress or don’t get enough sleep, our bodies sense a “threat” and release hormones like cortisol, adrenaline, and epinephrine. This stimulates the liver to create or release glucose and makes the liver acutely insulin resistant. This may be an evolutionary response designed to ensure we have energy to fight or flee, since historically “threat” probably meant that we had to use our muscles to escape a dangerous situation, so this glucose in the bloodstream may have been beneficial.

Now, since our stressors are largely psychological—annoying emails, traffic, smartphones pinging—this extra circulating glucose is not helpful. That may be why you see higher glucose levels when you’re stressed or coming off a poor night’s sleep.

When we don’t sleep enough, our bodies become quickly insulin resistant. In fact, research shows that when people sleep just one hour less per night (6.5 hours rather than 7.5–8.5 hours), they have to secrete 50% more insulin to get the same amount of glucose out of the blood. 

Fortunately, techniques that help us deal with stress can also improve our metabolic fitness. Studies show that simple actions like twice-weekly meditations or 20-minute daily breathing can reduce fasting and post-meal glucose levels. 

Read more about glucose and stress and glucose and sleep.

Captured at on Nov 09, 2020 by Stacie Flinner Photography.

USING LEVELS

How does Levels help my metabolic fitness?

By pairing a continuous glucose monitor with the Levels app, you can get real-time feedback on how your diet and lifestyle affect your metabolic health. Simply seeing a value for glucose is only part of the story. To make lasting change, we need to put that data in context. 

Our glucose levels respond to more than just what we eat. Meal timing, sleep, stress, physical activity, medications, microbiome composition, and micronutrient levels all play a role. Being metabolically fit doesn’t just mean severely limiting carbohydrates, it means eating in a way that minimizes glucose spikes, and trains your body to produce and use energy efficiently—this is metabolic fitness. 

The Levels app allows you to log meals, workouts, sleep and other things that might impact your metabolic health, then gives you both a Metabolic Score (your day’s rating) and a Zone Score (a meal’s rating) so you can match your choices with your results, the best way to change behavior over time.  

Read more about achieving metabolic fitness. 

When can I use Levels?

We are currently in a closed beta, working to optimize the product with our early adopters. Sign up for the wait list and we’ll keep you updated on availability. We’ll open the product to more and more people throughout this year.

Read more about Levels Secret Master Plan. 

Have more questions? Send us a note on @levels on Twitter. 

The post 11 Common questions about food choices, blood sugar and Levels appeared first on Levels.

So she offers practical advice that delivers tangible results. “I love to focus on metabolic health because it allows you to understand better what you feel is best for you, regardless of the specific diet,” Greunke says. Regardless of someone’s individual habits, she adds, optimizing blood sugar is usually a primary goal. 

That focus led her to try Levels, and she quickly appreciated the value of seeing real-time feedback tied to food choices.   

“A continuous glucose monitor helps people better understand what’s going on in their bodies and adjust accordingly,” Greunke says. “For example, watch how different your responses are from a plain apple versus one paired with almond butter. Once you see the data, making better choices becomes a no-brainer.”

As a mom to two young boys herself, Greunke knows how much anxiety can come with parenting—especially newborns—and how much tracking your diet can help. “Objective information helps you feel less like you’re the victim of anxiety and more in the driver’s seat,” she says. “You can say to yourself, ‘Okay, I realize how much these fluctuations in my blood sugar are contributing to me feeling those symptoms that I identified as anxiety.” 

Here, Greunke shares some of the tips and systems she gives her clients trying to fit metabolic health into a hectic life. 

1. Shop by ingredients, not labels

As consumers, we have to be a little bit skeptical about the things that we choose to put in our bodies, which starts with being aware that what the label says doesn’t necessarily mean the food is better for you. 

Labels aren’t very well-regulated and may not be completely reliable, as we’ve seen with terms like “net carbs.” (Let’s also not forget that there are more than 56 names for sugar, so even if the label doesn’t mention sugar, it still could be in there).

The parents that I work with can overspend on packaged products thinking they will make their health inherently better. Packaged products might make your life easier, and can add variety, but don’t get caught up in what labels claim as health benefits.

Instead, turn over the package and look at the ingredient list and nutrition facts, because that’s really where the gold is. You want to know exactly what ingredients are in it, and ask yourself: Is this something that I want to put in my body? 

Unpackaged whole foods don’t have a label because they don’t need one. If they did have labels, they’d look much better than what packaged foods offer. 

2. Think about food in pairs

Snacking smart isn’t something that comes intuitively. To most people, apples and granola bars seem like great healthy snacks. Others try to stay low calorie to lose weight.

But it isn’t just about the calories, it’s about having a metabolic response that will ultimately help with willpower and cravings later. 

For example, you can add a bit of peanut butter or almond butter to that apple, and it might be a higher calorie meal than what you’re used to, but that’s going to help you make better choices throughout the rest of the day, because it will keep blood sugar more stable, and create more satiety. Instead of craving more food after an hour of a snack, you may be able to wait until dinner before you’re hungry again.

How do you actually make this happen? Preparation and awareness. If you want to eat healthier, you have to have more nutritious stuff in your house. So start stocking your pantry and travel bags to make pairing easy.

When you grab a bag of apples at the grocery store, think about what you can pair them with. Have a mental checklist: “I want to have carbohydrates with something fatty, and protein for my snacks so I can enjoy the energy over the longer term.” 

3. Divide your day—and your plate—into thirds

Breaking your day into thirds is a useful mental compartmentalization to help new parents—or any busy person—make blood-sugar regulation and metabolic health a priority. 

The first third of the day is about understanding the importance of having a good breakfast to set yourself up for the rest of the day.

Then break your meal into thirds. Stop and think: Does it have fiber? Does it have fat? Does it have protein? Protein and fiber help with satiety, necessary phytochemicals, and antioxidants. Fat helps stabilize your blood sugar. From there, add carbohydrates that are going to work for you.

If you’re a vegetarian or vegan, you can choose plant-based options for protein like an organic tofu “egg” scramble or a high-quality plant-based protein powder. If you are a meat-eater, it could be things like eggs or breakfast sausage. It could even be leftovers from the night before. 

Parents think that they have to create all these recipes and elaborate meals, but when it comes down to just checking off those three components, nutrition becomes much simpler. Personally, I don’t do a ton of meal prep or recipe development, and I find that many of the parents that I work with don’t have the time or energy to do that either. 

Just make sure you’re having a balanced and complete meal in the morning versus just the last couple of scoops of your kid’s cereal. 

The second third of the day encompasses that lunch and after-lunch period. Using that ingredient meal framework, make sure you have a good amount of protein, a full plate of veggies, and then add fat.  

I have my clients test their lunch responses: How is their energy and hunger two hours after their second meal? If they’re hungry before that two-hour mark, then the meal composition wasn’t quite where it needed to be. Our goal is to extend the post-lunch satiety to three to four hours. 

I usually recommend a snack before dinner because dinnertime can be chaotic for new parents, and frankly, most people. This should be something more protein or fat-based, and if it is a carbohydrate, make sure it’s paired and not something that’s going to make you crash and crave.

Let’s not just have leftovers of your kids’ crackers, let’s have the crackers with some hummus or avocado on them. If you didn’t have a lot of protein for breakfast or lunch, this is a great time to have a grass-fed beef stick or protein powder. 

A good snack gives you the flexibility to put together a nourishing dinner versus waiting too long, getting hangry, and calling for delivery. 

For the final third of the day, we want to promote metabolic flexibility, and the choices made here can really make or break the day. 

We might have really great intentions, and start out with a solid breakfast and lunch, but as soon as that after-dinner hour rolls around, if we don’t have that definitive mindset of “Okay, we’re done, we had enough food for the day, we don’t need anything,” our decisions may completely overshadow our progress. 

The final third of the day is a matter of preventing a carba-palooza that will leave us going to bed feeling bloated and packed with energy when we don’t need it. Nighttime is a great moment to give your body to heal, rest, and repair. 

For most people, I recommend at least a 12-hour fast between dinner and breakfast. This could be as simple as stopping all eating at 6:00 PM until breakfast at 6:00 AM. 

4. Don’t forget that nutrition can be a lever for mood

Food is one of the most powerful tools when it comes to anxiety. We’re going to feel the impact of consistently putting our blood sugar in spike-and-crash cycles. 

When we feel mood swings, we might think it’s just a personal weakness. We look for ways to troubleshoot, whether through meditation, medication, breathing exercises, supplementation, or whatever. While these solutions can help, we need to get to the root cause of why we’re experiencing that irritability. 

Moms might not be getting enough protein, fiber, or fat during a meal, which then may lead to  a blood-sugar spike followed by a crash. We may have stretched the period between meals too long. Or the foods we eat aren’t setting us up for stable blood sugar. All of this could lead to mood instability.

If you can find ways to smooth your blood sugar, you won’t have to work so hard to counteract that sensation of anxiety that could be caused by swings in blood sugar. 

5. Teach your kids that what they eat affects how they feel

Kids, for the most part, can get away with more than adults can. They can get a higher amount of their calories coming from carbs without some of the more obvious negative health consequences. 

But they’re not immune from the same effects we get as adults. If they have refined sugars and unbalanced meals, they may have more tantrums, and they’re going to have to work harder to focus in school. 

Virtual schooling in particular can be very demanding for attention, and if kids are constantly swinging through hits-and-crashes of blood sugar, they’re going to have a much harder time with something that is already very hard to focus on. 

The solution isn’t to have your kid on a strict low-carb or keto diet, but to make sure their meals are well balanced, they’re eating regularly, and they’re avoiding those blood-sugar spikes and crashes. 

As adults, if we’re feeling shaky or irritable, it’s easier for us to understand we probably need to eat something to get our blood sugar stable. But for a kid, once their blood sugar gets too low, they have a hard time getting out of that tantrum. They can’t logic their way out of it.

As a mom to a four- and six-year-old, I’m starting these conversations about how food makes them feel and how sugar can make them feel a little bit more irritated or agitated after the initial energy boost. 

Ultimately, I’ve found that you can make life a whole lot easier for yourself and your family by being more mindful of your choices.

The post Stephanie Greunke’s nutrition advice for busy parents can help you, too appeared first on Levels.

These brain-focused clinicians and scientists illuminate how metabolic health impacts neurologic health.  

Lisa Mosconi, PhD

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Dr. Mosconi is Director of the Women’s Brain Initiative at Weill Cornell Medical College, where she studies and writes about the intersection of metabolic health and women’s health. Her book, The XX Brain, is the ultimate guide to the unique aspects of the female brain, how the brain changes over the course of a woman’s lifespan, and how to protect it through a healthy lifestyle that specifically supports metabolic health and minimizes processed foods. 

David Perlmutter, MD

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Dr. Perlmutter is a board-certified neurologist who focuses on how our dietary and lifestyle choices affect our brain health and propensity for neurodegeneration. His best-sellers Grain Brain, Brainwash, and Brain Maker have been instrumental in helping the public learn about how to maintain cognitive function and improve longevity. His site is rich with information about food and brain health, as is his podcast The Empowering Neurologist. 

Dale Bredesen, MD

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Dr. Bredesen has spent his career researching neurodegenerative diseases and looking for ways to reverse cognitive decline. His book The End of Alzheimer’s presents evidence that diet and lifestyle can do just that, and in particular, reverse insulin resistance in the brain. He runs the Apollo Health Institute, which has developed the ReCODE program for reversal of cognitive decline, putting his findings into practice. 

Austin Perlmutter, MD

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The other Dr. Perlmutter is a board-certified internal medicine physician, and writes the column The Modern Brain for Psychology Today. He’s also the co-author, with his father David, of Brain Wash: Detox Your Mind for Clearer Thinking, Deeper Relationships, and Lasting Happiness, which explains how sugar has dire effects on brain health. 

The Low-Carb Leaders 

These researchers unpack the science behind the ways low-carb, high-fat diets can address common diseases and chronic conditions. 

Dom D’Agostino, PhD

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D’Agostino, a Levels Medical Advisory Board member, is a research scientist who studies the physiological, cellular and molecular mechanisms behind metabolic health, with a particular focus on ketogenic diets. His KetoNutrition site is packed with research, recommendations and helpful links.  

Ben Bikman, PhD

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Bikman, also a Levels Medical Advisory Board member, is the author of the seminal Why We Get Sick, which explores the role insulin resistance plays across a number of conditions and diseases. He’s also a professor at BYU and the founder of nutrition coaching service InsulinIQ. Follow him on social media, where he shares research around obesity and insulin.

Jason Fung, MD

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A nephrologist by training, Dr. Fung has written two foundational works—The Obesity Code and The Diabetes Code—on using intermittent fasting and low-carb diets to treat metabolic disorders. He is also the creator of The Fasting Method, a site and program helping people achieve health through fasting. 

Bret Scher, MD

Twitter

Dr. Scher is a board-certified cardiologist and leader in the low-carb movement. He’s the medical director at Diet Doctor, a site full of videos, recipes and meal plans for eating according to these principles. He also hosts the excellent Diet Doctor podcast, where he interviews clinicians and experts about metabolic health.

The Evangelists

These are some of the most active voices in metabolic health, reimagining the way doctors, the healthcare system, scientists, and society approaches health. 

Peter Attia, MD

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Dr. Attia’s 2013 TED Talk questioning the way we think about diabetes sparked much  of the current focus on metabolic health. His hugely popular and highly scientific podcast, The Drive, is the leading show digging into the nuanced details of metabolic and overall health. We highly recommend signing up for his weekly newsletter, which is always useful and surprising.  

Mark Hyman, MD

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Dr. Hyman is one of the most prolific voices in helping people decode what makes a healthy life. We love his books Food Fix and The Blood Sugar Solution (he has written 13 in all), and every episode of his podcast The Doctor’s Farmacy will leave you with some actionable piece of knowledge. His core message frequently revolves around metabolic health as a foundation to overall health. His social media accounts also deliver daily inspiration and advice on eating and living better.

Sara Gottfried, MD

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Dr. Gottfried is a board-certified OB GYN who is one of the preeminent thinkers in the use of single-subject, or n-of-1, studies, and in approaching healthcare from a root-cause approach. She has written several books about the ways diet and lifestyle choices impact our brain and our hormones. Her blog and social media offer frequent posts about women’s health, hormones and diet—as well as delicious recipes. 

Rhonda Patrick, PhD

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Dr. Patrick is one of the best science communicators around, able to translate complex research topics into easy-to-understand pearls of insight. Her research spans aging, neurodegeneration and metabolism, and her podcast combines deep dives into DNA science with practical explainers like “The Biology of Breast Milk.” Her site has dozens of rigorously referenced articles and videos on all aspects of health and longevity. 

The Policy Shapers 

We’re not going to reverse the epidemic of chronic disease if we also don’t make changes to our food and healthcare policy. These are the advocates thinking and talking about how we do that. 

General Mark Hertling

Twitter

Hertling is a 40-year Army veteran who served on President Barack Obama’s Council on Fitness, Sports, and Nutrition. His TED talk on how obesity is a national security issue has been viewed nearly 2 million times, and he has been instrumental in sounding the alarm on how poor metabolic health is weakening the strength of our military. 

Robert Lustig, MD

Twitter

Dr. Lustig is a pediatric endocrinologist with a focus on childhood obesity and diabetes. His books Fat Chance, The Hacking of the American Mind and the forthcoming Metabolical connect the dots between what we eat, policy and business, and show us how to break out. Check out his site for information and commentary about current food policy initiatives, and watch him speak about it on his YouTube channel.  

Bill Frist, MD

Twitter

Dr. Frist is a former heart transplant surgeon and U.S. Senate Majority Leader who’s dedicated much of his post-Senate career to ringing the alarm bells about U.S. food policy, including the dangers of sugar. His podcast, A Second Opinion, is a must-listen for anyone interested in the intersection of food, policy and health reform and innovation. 

The Nutrition Experts 

These researchers focus on how nutrient-rich, whole-food plant-based diets are key to ensuring metabolic health. 

Cyrus Khambatta, PhD

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A Type 1 diabetic himself, Dr. Khambatta is a biochemist who studies the way food and lifestyle can reverse insulin resistance. The work led him to co-author Mastering Diabetes and found a site by the same name, which offers coaching for people with diabetes as well as an informative blog and recipes to reverse insulin resistance. 

Joel Fuhrman, MD

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Dr. Fuhrman’s work centers on the power of nutrition to address disease and make for a healthier lifespan. He coined the term “Nutritarian” to describe a diet that focuses on nutrients alongside calories. He’s written seven books, including his first best-seller Eat to Live. His site has a number of resources, including recipes and a blog. 

The Biohackers

These people have changed the way we think about self-quantification, digital health, and optimized performance. 

Molly Maloof, MD

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Dr. Molly, a Levels Medical Advisory Board member, is a visionary thinker on the relationship between the mind, body, environment, and technology. She consults for a number of tech and health startups, and is a practicing physician focusing on longevity and health optimization. She is also a lecturer at Stanford University, teaching a class called  “Live Better Longer: Extending Healthspan to Lengthen Lifespan.”

Dave Asprey

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Asprey is the “father of biohacking” and the creator of Bulletproof Coffee. He is a prodigious producer of content, with a blog, podcast and active social feeds with advice and insights into optimizing your lifestyle. 

Ben Greenfield

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Greenfield is an author, speaker, and former strength coach who is an expert on brain and body biohacking techniques for optimal performance. He hosts a weekly podcast interviewing experts and researchers. Of his many books, we recommend starting with Boundless—a tome of information on performance, nutrition, recovery, and longevity, with a strong focus on metabolic health. 

The Athletic Authorities 

These two clinicians offer unique insights into the way metabolic health affects athletic performance. 

Julie Foucher, MD

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Dr. Foucher is a former competitive CrossFit athlete, board certified family medicine physician, and functional medicine practitioner, whose medical practice also offers athletic training. With nearly 500k Instagram followers, her regular posts inspire followers to be active and make healthy choices. Her popular podcast, Pursuing Health, is a wealth of information on holistic living, and her site offers many articles.

Howard Luks, MD

Twitter

Dr. Luks is an orthopedist who publishes extensively on his blog, with clear, engaging articles about joint mechanics and injury, often revealing where convention advice gets it wrong. Start with these posts, where he lays out a clear and compelling case for the connection between metabolic health and joint health.  

And Four More We Recommend …

Each of these thinkers brings a unique take on metabolic health, our healthcare system and how we can do better.  

Frank Lipman, MD

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Dr. Lipman is a practicing functional medicine doctor and author of several books, including the comprehensive (and beautifully illustrated) How to Be Well, and the recent The New Rules of Aging Well, which goes deep into the relationship between glucose and aging. He writes frequently on his site about marrying ancient knowledge with modern medicine to achieve a healthy life, a system he calls Good Medicine. 

Max Lugavere

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Lugavere is a former journalist and author of Genius Foods, about eating to boost brain health and overall health. His social media offers some of the most practical advice out there on healthy diet and lifestyle choices, and he is a master at boiling down complex concepts. His weekly podcast features researchers and experts from across the wellness space. 

Chris Kresser, MS, L.Ac

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Kresser is a leading functional medicine practitioner and founder of The Kresser Institute, which trains clinicians in reversing chronic disease. He recently wrote Unconventional Medicine, which talks at length about how insulin resistance is at the root of many modern conditions. He hosts a a popular podcast and his site has several insightful articles; we recommend Why Hemoglobin A1c Is Not a Reliable Marker and Why Your “Normal” Blood Sugar Isn’t Normal (Part 1 and Part 2).

James DiNicolantonio, PharmD

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Dr. DiNicolantonio is a cardiovascular researcher and author of The Salt Fix, which presents an evidence-based argument to the orthodoxy that salt is bad for us, and even makes the connection between salt and blood sugar levels. His book, The Immunity Fix, looks at the relationship between immunity and insulin resistance. He works often on health policy, including testifying in the Canadian Senate on the harms of added sugars.

The post The 26 people in metabolic health you should know appeared first on Levels.

1. Why We Get Sick, Ben Bikman, PhD
   

   Levels medical advisory board member Ben Bikman reveals the link between insulin resistance and major conditions like cancer, heart disease, and Alzheimer’s—as well as a plan for preventing it. 

2. The Blood Sugar Solution, Mark Hyman, MD
   

   Cleveland Clinic Center for Functional Medicine’s Dr. Mark Hyman presents an overview of the epidemic of “diabesity,” and offers practical advice for losing weight and preventing disease through healthy metabolic living.

3. XX Brain, Lisa Mosconi, PhD
   

   Women are far more likely than men to suffer from conditions like depression, migraines, and strokes, and twice as likely to develop Alzheimer’s disease. Neuroscientist Lisa Mosconi explores how this may be rooted in poor blood sugar control, and how metabolic health declines as estrogen declines in menopause. She offers an empowering plan to address the unique risks of the female brain.

4. The Obesity Code, Jason Fung, MD
   

   Dr. Fung does a deep dive into why high insulin levels thwart weight loss, and offers a five-step plan for losing weight and keeping it off using intermittent fasting and breaking the cycle of insulin resistance. We also love The Diabetes Code, which looks at using the same tools to prevent and reverse Type 2 diabetes. 

5. The End of Diabetes, Joel Fuhrman, MD
   

   Dr. Furman argues persuasively that we can prevent and even reverse diabetes with the right nutrition choices. His “Nutritarian” eating philosophy focuses on the quality of carbohydrates, proteins, and fats and emphasizes a high micronutrient-to-calorie ratio.

6. Mastering Diabetes, Cyrus Khambatta, PhD and Robby Barbaro, MPH
   

   With actionable advice and recipes, this book describes how a whole-food, plant-based (WFPB) diet can reverse insulin resistance in all types of diabetes, including gestational. They believe that while the pervasive low-carb, high-fat keto dietary approach to glucose control may improve short-term metrics, it also increases long-term risk for chronic diseases like cancer, high blood pressure, high cholesterol, chronic kidney disease, and fatty liver disease. Both authors are scientists with Type 1 diabetes and have followed a high-carb WFPB diet while minimizing insulin need.

7. The Personalized Diet, Eran Segal, PhD and Eran Elinav, MD, PhD
   

   Segal and Elinav are responsible for the groundbreaking scientific research behind a core Levels concept: The way people respond to food is not universal. This book shows how you can create an individualized diet that works for you. 

8. Grain Brain, David Perlmutter, MD
   

   Neurologist Dr. David Perlmutter reveals the many methods by which the sugar contributes to neurodegeneration (which can eventually lead to diseases like dementia), how insulin resistance reduces the brain’s ability to function properly, and what you can do about it.

9. The Case Against Sugar, Gary Taubes
   

   Taubes has been an insightful critic of diet orthodoxy since he wrote a bombshell New York Times article about sugar in 2002, and here he turns his attention to all the ways sugar is killing us and how we got to this place. 

10. Brain Body Diet, Sara Gottfried, MD
    

    Dr. Gottfried explains the relationship between brain health and our overall health, and how both can be impacted by sugar consumption and poor metabolic fitness. She presents a comprehensive dietary and lifestyle plan to improve the well-being of our metabolic systems, and by extension, our brain.

11. Fat Chance, Robert Lustig, MD
    

    Dr. Lustig’s 90-minute video Sugar: The Bitter Truth helped millions of viewers see the destructive power of sugar. In this book, he dives deeper into the history and politics of our sugar-filled diet, and offers a plan for overhauling the global food system.

12. How to Not Die, Michael Gregor, MD 
    

    The man behind the incredibly useful Nutrition Facts website, Dr. Gregor looks at the top 15 medical causes of premature death in the U.S. and makes the evidence-backed case that diet and lifestyle choices play a larger role than you think. We particularly like the chapter on “How Not to Die from Diabetes.”

13. Wired to Eat, Robb Wolf
    

    In Wired to Eat, Wolf, author of The Paleo Solution, goes beyond paleo to look at how we rewire our brains for weight loss, including a 30-day Reset Plan to get your metabolic health back to normal.  

14. The Hacking of the American Mind, Robert Lustig, MD
    

    Another favorite by Dr. Lustig, this book dives deep into the ways corporate interest and government policy worked together to get us addicted to unhealthy lifestyles and offers both policy-level and personal advice for breaking free.

15. Food Fix, Mark Hyman, MD
    

    We like that this book takes the problems of obesity and food-related disease and puts them in the context of the global food system with an incisive look at the policies that make them possible. 

16. The End of Alzheimer’s, Dale Bredesen, MD
    

    Based on 40 years of research and experience, Dr. Bredesen argues that Alzheimer’s—which he breaks into three distinct conditions—can be reversed, with the right combination of diet and lifestyle choices.

The post Must-read books about metabolic health appeared first on Levels.

Look at a traditional holiday spread—mashed potatoes, honey-baked ham, warm bread, pies—and every step is a glucose landmine, just waiting to leave you passed out on the couch, feeling bad. Instead, this year give yourself the gift of great eats and steady energy all day by making some simple swaps in your holiday menu. Don’t worry about a dinner table revolt: We promise each of these ideas is a delicious alternative, and can help keep your blood sugar stable, which means more joy now and for holidays to come.

The swap: Traditional Eggnog → Keto Eggnog

Why it’s better: Standard eggnog recipes call for up to a cup of refined sugar. That’s like eating a half-dozen candy bars. This recipe keeps all the eggy, frothy goodness, but replaces dairy milk with almond or macadamia nut milk and gets its sweetness from allulose, a natural sweetener alternative endorsed by Dr. Peter Attia. 

Credit: CleanGreenSimple

The swap: Regular crackers –> Flax-seed crackers

Why it’s better: Get the sugar-spiking refined white flour off the hors d’oeuvres table this year by putting out crackers made entirely of flax seeds. Whether you make your own or buy a box, this alt snack is loaded with omega-3s and fiber. And don’t forget to set out the crudités with lots of cruciferous veggies like cauliflower and broccoli, which contain a compound called sulforaphane, which has been shown to increase insulin sensitivity.  

Credit: A Saucy Kitchen

The swap: Mashed potatoes → Cauliflower mash

Why it’s better: It’s not just sugar that can spike your glucose levels; high-carb foods like potatoes can do it too. That’s because they tend to have a high glycemic index (GI), which means the body breaks down their carbs into glucose faster, which can cause a quick rise in blood sugar (of course, everyone’s glucose response to carbohydrates will be different, so you can test for yourself). Mashed cauliflower has a great nutty taste, is incredibly creamy, and has a lower GI. 

Credit: The Endless Meal

The swap: Traditional gravy → Mushroom gravy

Why it’s better: The roux that thickens gravy is typically made with white flour, a refined grain that’s typically not great for stable blood sugar. This mushroom sauce subs in cashews instead. Plus, a recent study found that white button mushrooms may alter the gut microbiome in a way that promotes better glucose regulation.       

The swap: Glazed ham → Grass-fed or game meat

Why it’s better: Search for “Holiday Ham” and you’ll find recipes that call for up to 1.5 cups of sugar in the glaze. If you eat animal protein, go for game meats like venison or elk, which are lower in fat; grass fed and finished red meat, or pasture-raised poultry, or salmon. In general, high quality meat means more omega-3s and no antibiotics — two things that are important in supporting metabolic health. Stick with simple roasting and skip the glazes and sauces, which can have a lot of hidden sugar.  

Credit: Minimalist Baker

The swap: Gingerbread cake → Almond flour gingerbread cookies, almond flour cake with caramel frosting, or black bean brownies

Why it’s better: One key to any metabolically friendly desert is to lose the refined flour. Almond flour has a lower GI, more nutrients and may have other health benefits. If almonds aren’t your thing, try black beans, which is high in protein and has a rich flavor that pairs well with cocoa. 

More great healthy ideas:

• Roasted asparagus and mushrooms – Eating metabolically well doesn’t just mean losing sugar, it also means getting plenty of fiber and micronutrients, which are plentiful in roasted veggies.
• Keto Cranberry Sauce – This recipe swaps out the sugar for natural alternative monk fruit 
• Beet sauerkraut – Fermented foods contain probiotics that can be beneficial to our gut microbiome, and this recipe adds beets for extra color and flavor. 
• Brussel sprout tahini salad – Tahini, made from ground sesame seeds, is a great source of healthy fat, which helps blunt blood sugar spikes. 

Your holiday-cooking cheat sheet:

What’s missing from Levels’ holiday meal suggestions? 

• Refined flour
• Refined sugar
• White potatoes 
• Starchy vegetables
• Refined seed oils
• Salads with dried fruit 
• Breaded/fried foods  
• Honey
• Maple syrup

What’s included in our pro-metabolic menu?

• Thoughtfully sourced proteins
• Fiber (flax, beans) 
• Omega-3 fat sources
• Thoughtfully chosen sugar substitutes, like monkfruit and allulose, not artificial sweeteners like saccharin 
• Lots of micronutrient rich foods to support metabolic functioning 

The post Holiday recipes that won’t spike your blood sugar appeared first on Levels.

Establishing the Glucose-COVID Connection Across Multiple Studies

The Study: Admission Hyperglycemia in Non-diabetics Predicts Mortality and Disease Severity in COVID-19: a Pooled Analysis and Meta-summary of Literature

What it Says: This study demonstrates the correlation between high blood sugar and worse COVID outcomes by analyzing data from several other studies looking at this question, including early studies out of Wuhan as well as more recent studies in the US. Researchers examine 10 studies in all, and find that as fasting glucose levels went up, so did severity of COVID in hospitalized patients.

About half of people hospitalized with COVID can develop acute hyperglycemia—that is, their blood sugar goes up as they’re sick with the disease. But these studies also looked at people’s blood sugar when they were admitted to the hospital, and found that patients with elevated levels were three times more likely to die of COVID than those with normal blood sugar. The authors suggest that given the strength of the findings, controlling blood sugar in COVID patients could be crucial to managing the severity of the case.

Why is increased glucose so dangerous for COVID patients? For starters, glucose promotes inflammation and creates compounds called reactive oxygen species (ROS), which may contribute to the “cytokine storm” seen in many severe cases. What glucose values seem to be best? In one of the studies mentioned, fasting glucose on admission of less than 106 mg/dL was associated with significantly fewer complications compared to people with higher levels. 

Levels Take: There have been several studies since the first one in June linking high glucose in non-diabetic populations to worse COVID outcomes, but these kind of large scale meta-analyses, in which researchers look at large data sets, are especially helpful. This study shows that elevated fasting glucose levels at hospital admission are related to higher mortality from COVID, regardless of whether the patient had been diagnosed with diabetes. Given that, we agree with the paper’s conclusion: “The need for timely recognition and management of blood glucose levels should be emphasized in COVID-19 disease.” It’s time that we put resources into helping people improve blood sugar on a large scale.  

Seeing the Effect on a Large Sample

The Study: Admission hyperglycemia as a predictor of mortality in patients hospitalized with COVID-19 regardless of diabetes status: data from the Spanish SEMI-COVID-19 Registry (PDF)

What it Says: This recent study from Spain also makes the connection between high glucose levels and worse COVID outcomes, independent of diabetes diagnosis. What’s powerful is the sample size: The researchers look at the records of more than 11,000 people; many of the previous studies had sample sizes under 1,000. This gives us even more confidence in this correlation.

The study also discusses inflammation, suggesting “early correction of hyperglycemia in the course of COVID-19 could result in a decrease in the release of inflammatory cytokines… resulting in better outcomes.” The authors outline other reasons, beyond inflammation, that high blood sugar relates to worse COVID outcomes, and why hyperglycemia often gets worse in patients fighting COVID.

First, SARS-CoV-2 can infect pancreas cells via ACE2 receptors, impairing the organ’s ability to create insulin, which helps regulate glucose. There’s also a relationship between hypoxia—not getting enough oxygen, a common symptom of COVID—and impaired glucose metabolism. Normally, glucose processing produces ATP, our cell’s form of energy. In low-oxygen conditions, glucose metabolizes into lactate, which produces less ATP. Hypoxia and low ATP levels mean higher circulating blood lactate and a compound called lactate dehydrogenase (LDH). And elevated LDH has also been associated with higher COVID mortality. So far only one small study has looked at using oxygen to correct this anaerobic glucose metabolism at the early stages of COVID, but it’s an area that deserves more research.

The study shows that of people admitted to the hospital with high glucose levels (between 140-180 mg/dL), only 38 percent had a prior diabetes diagnosis. This suggests that there may be a significant amount of undiagnosed diabetes in the population, or that the virus worsens glucose control. In terms of death rates in the hospital, diabetes diagnosis didn’t matter: high glucose at admission equaled higher mortality. 

Levels Take: This research is piling on evidence of the dangers of high blood sugar for COVID patients—but it’s a big pile of evidence. And it underscores 1) how vital it is that hospitals screen patients for hyperglycemia at admission and treat it early; and 2) how important it is to control your metabolic health, all the time. We know that only 12 percent of people are metabolically healthy—that leaves a big potential pool of people that could suffer unnecessary additional risk if they’re unlucky enough to get sick with COVID.

Finally, we agree with the authors’ suggestion that providing glucose monitoring to patients who are asked to stay at home during the early stages of infection would be extremely valuable given what we now know about COVID and metabolic health. 

Creating a Way to Manage Glucose in Hospitalized Patients

The Study: Managing Hyperglycemia in the COVID-19 Inflammatory Storm

What it Says: This study from the University of Michigan looks at COVID patients in Michigan to better understand why high blood sugar seems to worsen outcomes, and what can be done about it. The study notes that a pattern of severe high blood sugar was seen in a large proportion of patients—not just those with prior diagnosis of diabetes, prediabetes, or severe obesity—and that many of these patients rapidly worsened.

Building on previous research, the authors believe the low-grade, persistent inflammation associated with hyperglycemia “promotes fertile ground for the virus’ inflammatory surge, resulting in severe insulin resistance and severe hyperglycemia.” This creates a damaging cycle: People with high blood sugar are more likely to get more seriously ill, which further raises their blood sugar. The researchers also created a protocol for assessing a patients’ hyperglycemia and treating it with insulin while they are hospitalized, aiming for a glucose goal of 150-180 mg/dL in most patients.

Levels Take: We chose to highlight this research because it’s an interventional study, meaning the authors tested a glucose management protocol on patients, rather than just reviewing existing data. And it adds to the literature about the mechanisms behind the impact of elevated glucose on COVID. Finally, the treatment protocol is an actionable, potentially life-saving aspect of this research: It helps nurses treat hyperglycemic patients while keeping themselves safer. This article goes deeper into that part of the study.

Uncovering a Surprise: Low Glucose Can Also Cause Problems

The Study: J-shaped association between fasting blood glucose levels and COVID-19 severity in patients without diabetes

What it Says: This study out of Wuhan, China correlates the blood glucose levels of 293 non-diabetic COVID patients with the severity of their illness, and finds a J-shaped curve. That means that not only were people with the highest glucose most likely to have negative outcomes, but people with low fasting glucose (85 mg/dL and below) also fared worse than those with fasting glucose in the higher end of the normal range (85-93 mg/dL).

The J-shaped curve between glucose levels and COVID severity.

While this study doesn’t specifically investigate why lower glucose can worsen the disease, the authors speculate based on other research that it’s an energy shortage problem. COVID replication consumes a lot of the body’s ATP, which is made by metabolizing glucose. So if you already have low glucose, and therefore low ATP, and then COVID consumes even more ATP, your body simply doesn’t have enough energy left to mount a robust immune response. Your body also needs glucose to generate antioxidants like glutathione, so low glucose could also impair your antioxidant defenses.  

Levels Take: Two things strike us about this study. First, if the finding holds up under further research, it’s fascinating that low blood sugar would lead to worse outcomes (though the proposed mechanism around ATP makes sense: the body needs energy to fight off the disease). It’s a reminder of just how fundamental metabolic processes are. Second, it’s indicative of how much we have yet to learn about COVID and how it interacts with the body. That the story of high glucose and COVID is so clear already underscores the strength of the connection, but as researchers dig further into data, we will surely find more unexpected results like this one. 

The post Studies show high blood sugar increases COVID risk appeared first on Levels.

Inflammation is usually divided into two types: acute and chronic. Acute is the type that most people think of when they hear inflammation. This is what happens right after you cut yourself, brush up against poison ivy, or get an infection like the “common cold” or the flu. Your body sends out white blood cells that assess the situation and signal for reinforcements to attack the problem via chemical mediators, such as histamine, that can trigger specific cellular changes. As a result of this assault, you may experience one or more of the five most common symptoms of acute inflammation: redness, pain, swelling, warmth, and loss of function (e.g., difficulty bending an inflamed joint).

Inflammation is also responsible for most of the symptoms you have when you “feel sick,” like fever, chills and fatigue. While these can be annoying or uncomfortable, they are an indication that the body is doing its job protecting you. Without inflammation, even simple infections could become deadly. In most cases, once the harm is dealt with, the body can heal and return to normal—this usually takes somewhere between hours and days.

However, sometimes the inflammation never gets better and instead turns into a process that lasts for months or years—this is chronic inflammation. It may occur in response to an abnormality in the body, like cholesterol plaques in your arteries (atherosclerosis) or toxins from smoking. In many cases, chronic inflammation does not have a definitive cause. Sometimes the body attacks itself even though there is no injury or harmful agent floating around; this leads to auto-immune diseases, like rheumatoid arthritis and inflammatory bowel disease. Symptoms can range from very mild to severe, and even people with the same condition can have varying degrees of symptoms. Over time, chronic inflammation can cause permanent damage to cells and tissues.

How Do We Measure Inflammation? 

Sometimes blood tests can help confirm the presence of chronic inflammation by measuring for particular markers. Erythrocyte sedimentation rate (ESR) is a common test. It looks at how fast red blood cells settle to the bottom of a tube of blood. Normally, the cells settle slowly, but if you have inflammation they sink faster. This is a non-specific test, meaning that it only tells you if you have inflammation, not the cause. Another blood test measures your C-reactive protein (CRP) levels. During an inflammatory response, the liver makes CRP and releases it into the bloodstream. In general, higher levels of CRP indicate the presence of inflammation, but this test also does not identify the root cause.

Another potential marker of inflammation is uric acid (UA). Uric acid is usually a byproduct of DNA/RNA breakdown or the metabolism of ATP, the energy currency of your cells. High levels of uric acid may be present in and contribute to proinflammatory medical conditions like heart disease and diabetes. Research is still needed in this area, but some studies suggest that not only do uric acid levels potentially correlate with inflammation, but they may also precede insulin resistance, which can then lead to diabetes. 

Inflammation is important regardless of whether you feel it happening. Chronic inflammation has been linked to cardiovascular disease, diabetes, dementia and depression, among other conditions. Knowing you have inflammation can encourage you to identify risk factors that you can control and change, like sugar intake, that could lower chronic inflammation.

How does excess sugar affect inflammatory markers?

It is important to make a distinction between the different types of sugars in our food. One way that food sugars can be categorized is based on how they affect your blood glucose levels—this is called the glycemic index. Foods that cause a spike in blood glucose levels after a meal are said to have a high glycemic index. These include the refined carbohydrates that you have probably been told to avoid. Refined carbohydrates have had their fiber removed (along with other nutrients) and are found in bread, white sugar, cakes, cookies, crackers, tortillas, white rice, and many cereals. Foods that raise your blood glucose levels quickly have been associated with elevated levels of inflammatory markers, like CRP.

You may have heard that different types of sugar like fructose, high-fructose corn syrup, and sucrose (table sugar) can cause more or less inflammation, but so far studies have not shown a difference in the levels of inflammatory markers among kinds of sugars. That is not to say that they don’t affect your body in different ways, as we’ll address next, but there does not seem to be a difference in how they affect blood tests like CRP. 

What does high blood sugar do to your body?

Eating too much of any type of sugar can lead to spikes in your blood glucose levels, also called hyperglycemia. In most healthy people, the body responds to these spikes by releasing insulin, a hormone that works to bring glucose levels back down to normal. If, however, you repeatedly have too much glucose in your body, over time the cells become “numb” to insulin, causing blood sugar to rise. This state is known as insulin resistance and it is proinflammatory, potentially causing damage throughout your body. 

One target of these harmful effects is your endothelial cells, the cells that line your blood vessels. Repeated levels of high blood sugar can cause your blood vessels to produce damaging reactive molecules called free radicals, via compounds called advanced glycation end products (AGEs). Too much free radical activity generates oxidative stress, damage to endothelial cell function, and inflammation in the blood vessels. Hyperglycemia can also cause oxidation of free fatty acids stored in your fat cells, which contributes to inflammation.

In addition, glucose causes the oxidation of low-density lipoprotein (LDL), increasing your risk of plaque build-up in your blood vessels. Another negative effect is that high blood sugar levels promote blood vessel constriction and platelet clumping, which can promote blood clots.

Lastly, we all know that excess sugar leads to weight gain, which in turn increases your risk of other medical problems like obesity, high blood pressure, and many more. What’s more, excess fat tissue—particularly around the waist—promotes immune cell activation and secretes large quantities of proinflammatory chemicals. Diabetes, which is fundamentally a disease of glucose dysregulation, is itself a severe proinflammatory state. 

What long-term health problems can inflammation cause?

In light of the detrimental effects that high blood glucose levels can have on the body, it should not come as a surprise that many health problems are related to hyperglycemia and inflammation. Long-term inflammatory diseases are the most significant cause of death worldwide. While chronic inflammation may be present without symptoms or only mild findings initially, it contributes to many long-term health problems, including:

• Cardiovascular diseases, including heart attacks and strokes: There is a relationship between inflammatory markers, like high-sensitivity CRP (hsCRP), and risk of cardiovascular disease. Also, atherosclerosis (plaque buildup in your blood vessels) involves chronic low-grade inflammation and is the main culprit in heart attacks and strokes.
• Obesity: Fat tissues secrete inflammatory chemicals; the higher your body mass index (BMI) the more pro-inflammatory compounds you have circulating in your body. This may partially explain why obesity increases your risk of heart diseases, diabetes, and cancers.
• Cancers: Inflammation seems to play a role in cancers, including kidney, prostate, ovarian, hepatocellular, pancreatic, and colorectal.
• Diabetes: Immune cells affect your pancreas, which produces insulin, and the presence of inflammatory markers further highlight diabetes’ relationship with chronic inflammation. This inflammation also leads to many of the complications associated with diabetes, like diabetic retinopathy, neuropathy, and nephropathy, as well as the increased risk of heart attacks and strokes.
• Rheumatoid arthritis: Chronic inflammation in your joints that can lead to permanent damage and loss of function.
• Lung diseases like asthma and chronic obstructive pulmonary disease: Inflammation from irritants lead to lung problems.
• Alzheimer’s disease: Chronic inflammation is linked to cognitive decline and dementia.

What can you do to limit inflammation?

While it may seem like inflammation is everywhere, there are steps that you can take to limit it.

Changes in your diet are among the easiest ways to decrease inflammation. Avoid refined carbohydrates, sugary beverages, and other foods that cause spikes in your blood glucose levels. Instead, increase your consumption of fiber, fruits, vegetables, nuts, seeds, and other low-glycemic-index foods, all of which may help lower your risks of cardiovascular disease and diabetes. The plant chemicals called polyphenols in green and black teas have been shown to lower levels of inflammatory markers, like CRP. Curcumin, present in turmeric, has been shown to help with inflammation in animal studies.

You already know that exercise, especially moderate intensity exercise, can help with weight loss—but it may also decrease the levels of proinflammatory chemicals in your body, regardless of how much weight you lose. And exercise decreases your risk of heart disease, diabetes, obesity and other medical problems, so it’s an all-around winner when it comes to improving your health.

Smoking and stress are two other factors that can increase inflammation. Similarly, people with sleep disorders, or who simply don’t get enough sleep on a regular basis, are at higher risk of having chronic inflammation.

Inflammation is an important part of your body’s defense systems, especially when it comes to fighting infections. However, it can also wreak havoc in your body if left unchecked, especially over the long run. Positive lifestyle choices that limit inflammation can go a long way toward keeping your body healthy.

The post Inflammation and glucose levels: How high blood sugar can turn a good system bad appeared first on Levels.

Johnson was already highly mindful of his nutrition, eating a low sugar and carb diet, when he started using Levels last summer at the suggestion of trainer to the pros, Mike Barwis. Johnson quickly found out how valuable personal feedback can be. He cut out berries that spiked him and realized pasta—a previously forbidden food—worked as long as he had protein with it.

“I just learned so much for two weeks, every day. I started getting lean. My energy was consistent,” he says. “I always thought I was honing in nutritionally, but this is the first time I’ve seen a significant change, because I’m finding out what works for Jack.”

Here’s what Johnson had to say about getting addicted to the Levels experience, preparing for life after the NHL, and finding his go-to order at the ice cream shop.

On his early attempts to eat well as a professional athlete:

When I was young I was fairly small, so I just ate whatever I could, trying to get bigger and stronger. I didn’t start paying attention to nutrition until I turned pro, when I was 20 years old. I was around guys that were more health conscious, and I started to learn from them. But really I was just mimicking what they were doing.

When the whole gluten fad hit, I thought, “Hey, maybe something miraculous will happen to me if I go gluten free.” Nothing did. Then I tried going no carbs and no sugar. And that didn’t change anything for me. I didn’t feel like my performance really changed. I was just hungry all the time. I’d get to lunch and think, “There’s only so many salads I can eat every day,” and I’m just bored with it.

With something as extreme as no carbs and no sugar, I at least expected my body fat to drop to, like, three percent, and it never did. My wife would laugh and tell me, “You literally look no different.” And I’d think, “Well, that was a waste.” All I did was make life more difficult.

I realize now I was just playing a guessing game.

On discovering Levels in the off season through his trainer, Mike Barwis:

I approached Mike about the nutrition aspect of my summer training and he said, “Hey, you’ve got to try this. It’s awesome. Just eat what you normally eat, and you’re going to learn from there where to go.”

After a few weeks, Mike said to me, “You look a lot leaner than you normally do. How’s it going [with Levels]?” And I said, “It’s great. I mean, I’m addicted to it.” I’m scanning my arm every half hour. My wife would joke, “Are you taking another picture of your food?”

I think the best I ever felt was this summer, when I started monitoring my glucose level, because I could eat in a normal way, monitor my glucose level, and I see that I was in the green. I just found things that worked for me.

No two human beings are genetically built the same. We’re just not. And so what works for somebody, doesn’t work for someone else. This is the first tool I’ve seen that you can really find out what works for you.

On Levels opening up his food choices rather than restricting them:

I was told years ago that a lot of players switch to rice instead of pasta for their pregame meals because it was lighter, it didn’t have as many carbs. It’s supposed to be better for you. So that’s what I did.

After I started using Levels, I was at an Italian restaurant and it was my splurge meal, so I ordered chicken Francese over pasta. It was unbelievable. I must have had four or five pieces of it. I was checking my Levels app, and I just kept waiting for the spike, waiting for the spike. A couple hours went by and no spike. What I learned was that there was so much protein in that meal, my body leveled out the pasta.

So last night we had a big family dinner, and there was a choice of chicken parm or salmon. Normally I’d be thinking, “Man, I can’t enjoy this dinner at all.” I’d grab my piece of salmon and sit at the end of the table, and everyone would look at me like, “What a weirdo.” But knowing what I know now about my body, I had a bowl of Alfredo, and a bunch of salmon to get my protein, and I never spiked.

Peanut butter was another big one. Apples and peanut butter are a main snack for me. I expected there to be enough sugar between the apples and the peanut butter for it to spike me, but the app would rate it as a zone score of nine [out of 10]. Now, there’s an ice cream place down the street we take the kids to on the weekends. So with this lesson in mind, I asked them, “Hey, do you guys put actual peanut butter in the milk shakes, or is it peanut butter flavored ice cream?” They said, “No, we put regular peanut butter in.” So I had them throw me a peanut butter milkshake, and my Levels reaction wasn’t terrible.

I feel like I’ve got so much more freedom to eat. By learning what doesn’t work for me, I’ve opened up so many more doors. I don’t have to worry as much, and feel like I’m limited to like five things on the menu.

On staying healthy after he retires:

This is something that’ll carry on way beyond playing pro. I mean, I’ve got a whole second half of my life to live after hockey, hopefully. And this is going to be a tool that I use for a healthy life. It’ll allow me not to stress out when I’m done playing, and think “Oh, man, I’m not burning as many calories. I can’t eat anything now.” No, I can still live a normal life.

On why anyone can benefit from Levels:

Dieting is hard for people because A, they don’t know any better—sometimes you don’t know what you don’t know. Or B, they just don’t want to. And having Levels would allow them to maybe open some doors that they didn’t think were possible. So you can still have a sandwich, because maybe wheat bread doesn’t affect you like you thought bread would. Still having those things in your life might be an easier segue into getting healthy than just eating broccoli and going to the gym every day.

As a professional athlete, a lot of my job is performance, so this is tied to it. But anybody who wants to feel better or look better could use it. That could be a school teacher, or someone who works a corporate job—anyone that feels sluggish during the day. The reward for feeling better and eating what’s good for you? There’s no measure on that for whether you’re an athlete or somebody else. I mean, that’s a quality of life that’s priceless.

The post How NHL player Jack Johnson stopped stressing about his diet appeared first on Levels.

Almost 80% of people undergoing natural menopause have hot flashes, and about 30% report frequent or severe symptoms. These are called vasomotor episodes (because they’re related to constriction and dilation of the blood vessels) and researchers attribute them to ovarian changes in early menopause that cause  spikes and dips in how much estrogen the body produces.

Although researchers don’t know exactly the role glucose plays in triggering these effects, there is pretty strong evidence from large studies that metabolic conditions like insulin resistance and diabetes seems to make them worse. While other research suggests these symptoms are the result of too little glucose in the brain because of changes in glucose transport during menopause, this does not likely mean that more glucose is better during menopause. (In fact, post-menopausal women already have an increased risk of metabolic disease.)

Rather, it’s more likely that the changes that lead to that glucose shortage, combined with the effects of insulin resistance, make the brain less able to use glucose effectively. Maintaining stable glucose levels over time through healthy diet and lifestyle may be your best bet for managing menopause symptoms.   

The Links Between Metabolic Health and Menopause

There is substantial research on the links between vasomotor symptoms and metabolic diseases. Not all the research agrees, but some large, longitudinal studies find significant correlations. 

A study of about 150,000 postmenopausal women, followed over 20 years, linked hot flashes and night sweats with an 18% increased likelihood of diabetes. The correlation was higher in patients with more frequent and severe symptoms. Another study of more than 3,000 overweight women followed for eight years linked hot flash symptoms to higher insulin resistance and fasting blood glucose levels.

In a study of 17,000 postmenopausal women, researchers saw that eating a diet low in fat and high in vegetables, fruits, and whole grains can decrease hot flash frequency. In some cases, they saw that weight loss of ten pounds can potentially eliminate vasomotor symptoms. Weight loss and healthier diets improve insulin sensitivity, which promotes better glucose control.

Why Menopause Symptoms Are Connected to Metabolic Dysfunction

Research has not yet fully explained the link between increased menopause symptoms and metabolic dysfunction like insulin resistance. The two conditions share some risk factors, such as elevated BMI, but those factors alone don’t seem to explain the connection. 

Hot flashes set off the autonomic nervous system, which regulates our basic bodily functions like temperature. During a hot flash, heart rate and blood flow to the skin increase, skin temperature spikes, and then plummets as the body starts giving off heat. 

The autonomic nervous system also plays a role in the glucose regulation, so one theory is that the autonomic system changes present in hot flashes are also associated with increased glucose and decreased insulin production.

Another hypothesis is that night sweats disrupt sleep, and getting poor sleep or not enough sleep can throw off our body’s ability to process glucose effectively. One observation that may bolster this theory is that women whose symptoms lasted longer—meaning they had longer periods of disrupted sleep—had greater risk of diabetes.

A Novel Theory: The Brain, Glucose and Menopause

Researcher Sharon Dormire, PhD at Texas A&M also studies the potential link between glucose and hot flashes. Glucose levels in our body can be impacted by everything from daily sleep, exercise, diet, and stress levels, as well as overall insulin sensitivity. In studies on humans in experimental settings, Dormire has seen people experience fewer hot flashes after eating, and more hot flashes when blood glucose falls between meals. 

Dormire hypothesized that changing estrogen levels cause a drop in the amount of a glucose transporting protein made in the blood-brain barrier. These changes would decrease the rate at which glucose is transported into the brain, causing dips in its energy resources. Dormire’s theory is that this lack of energy activates the autonomic nervous system and triggers a hot flash, releasing glucose and providing the brain much-needed fuel. 

A small experimental study by Dormire analyzed ten postmenopausal women who stopped taking hormone therapy and experienced hot flashes. When their blood glucose was over 130 mg/dl—above a normal range—the women were much less likely to have hot flashes than when their blood glucose stayed below 110 mg/dl.

Dormire is currently using CGMs and hot flash monitors to test this idea. She has patients come into the lab and perform cognitively strenuous tasks to see if they trigger hot flashes. So far, Dormire said, she’s seen that these challenging psychological tests can effectively stimulate a hot flash when a patient is fasting, and therefore has lower glucose levels, though this research is yet to be peer-reviewed or published. 

What Does This Mean for Menopause and Glucose?

The studies linking insulin resistance with worse menopause symptoms seem to contradict Dormire’s theory that hot flashes are due to low glucose in the brain: People with hot flashes tend to be more likely to develop insulin resistance, yet those same people tend to have higher glucose levels.

What is important to remember is that insulin resistance in the brain makes it harder for brain cells to transport glucose into brain cells to produce energy. So even though someone with insulin resistance may have more glucose in their blood, that extra glucose still may not be making it to the brain to supply adequate energy.

With this in mind, a more effective strategy to mitigate hot flashes is might be not to increase glucose levels through diet or more frequent meals, but might rather be to improve insulin sensitivity by stabilizing glucose levels over time and keeping glucose in a healthy range. Sharp spikes and dips in blood glucose tend to promote insulin resistance over time, and stimulate the autonomic stress response in the body.  Keeping glucose elevation after meals low by choosing foods that have less of a glycemic impact, in addition to other insulin sensitizing strategies like getting adequate sleep, managing stress, and exercising regularly, could over time allow the brain to be more responsive to the glucose circulating in the body. 

While there are many gaps in our knowledge about hot flashes, we know some behaviors can help mitigate them. Hot flashes are more common in smokers and people with higher BMIs, and some research notes stress, spicy food, and red wine as triggers. If you’re having frequent or severe hot flashes or episodes of night sweats, check with your doctor for other signs of metabolic syndrome and diabetes. 

Although more research needs to be done on the links between metabolic health and menopause, the basic science is so far a hopeful indicator that by improving  insulin sensitivity, and keeping blood sugar levels stable throughout the day so as not to trigger an autonomic response, it might be possible to prevent or ease hot flashes and night sweats.  

To learn more about concrete steps you can take to help maintain healthy glucose levels, see  the article “12 Glucose Lowering Strategies to Improve Metabolic Fitness” and our “Ultimate Guide to Metabolic Fitness.” 

Jennifer Welsh is a Connecticut-based science writer and editor with over ten years of experience. Before becoming a writer and editor, Jen spent several years at the lab bench, doing hands-on cancer research, then joined the team of an antiviral drug discovery startup. Jennifer’s goal as a science communicator is to clearly and concisely share quality, accurate information to help make your life healthier and happier.

She’s previously worked and written for WIRED Science, The Scientist, Discover Magazine, LiveScience, and Business Insider. She has a Bachelors degree in Biological Sciences from The University of Notre Dame and a Graduate Certificate in Science Communication from the University of California, Santa Cruz.

The post Metabolic health & menopause: Is glucose partly to blame for hot flashes? appeared first on Levels.

The actual term “insulin resistance” is somewhat inaccurate; at least when considered in the context of the human body, it fails to encompass some necessary nuance. All cells in the body respond to insulin. All of them. From liver to lungs, brain cells to bone—they all contain insulin receptors. These insulin receptors act as doors for insulin to come and “knock”, which then elicits an effect within the cell. The effect depends on the cell. In some cells, like muscle and fat, insulin stimulates the uptake of glucose—this is insulin’s most famous effect, but it’s far from its only job. Most cells of the body, such as the liver, don’t need insulin to pull in glucose, but they still need insulin to help it know what to do with nutrients like glucose and fat. But insulin also has other effects in numerous cells that have nothing to do with nutrients; its effects vary depending on the cell.

When a cell loses its responsiveness to insulin, which can happen as a consequence of various conditions, it becomes insulin resistant. So, the term “insulin resistance” derives from the compromised insulin effect at the level of specific cells. This is one of the two pillars of insulin resistance: some cells don’t respond to insulin.

If we zoom out from the individual cells and view the entire body, we then see the second pillar of insulin resistance: elevated insulin. Increased insulin, known as hyperinsulinemia, is both a cause and consequence of the insulin resistance at cells. It’s also fundamental to many of the diseases associated with insulin resistance (more on that later). That too much insulin can cause insulin resistance is well established, including data from my own lab. Of course, as cells in the muscle or liver become insulin resistant, glucose levels rise (i.e., the muscles consume less glucose; the liver releases more glucose into the blood). This elevated glucose, in turn, elicits a greater insulin level, which, when chronically elevated, further drives insulin resistance.

Thus, the key features of insulin resistance are 1) blood levels of insulin are higher than they used to be and 2) insulin doesn’t work as well at certain cells. The combination of these events explains why insulin resistance is connected to so many health disorders. Whereas the insulin resistant cells barely respond, despite the elevated insulin, those cells that are still insulin sensitive are inundated with responding to insulin; they’re now over-stimulated.

Let’s look at some examples to better understand why this becomes such a problem. First, our muscle cells are among those that become insulin resistant. This has serious problems with glucose control, insofar as muscles are responsible for consuming up to 80% of the glucose after a meal. In contrast, the theca cells of the ovaries remain insulin sensitive even as the muscles (and other cells) become insulin resistant. This creates a fascinating and tragic problem. Briefly, insulin normally acts to mildly inhibit the ovaries ability to convert testosterone into estrogens, but this conversion is always happening and it’s essential for ovulation. However, with too much insulin, the sex hormone conversion is compromised, resulting in ovaries that are releasing too much testosterone and too little estrogens. This is the fundamental problem of polycystic ovarian syndrome (PCOS), the most common form of infertility in women. At its core, it’s a problem of too much insulin preventing the ovaries from doing what they’re supposed to do.

Now you know what too few do: what is insulin resistance and why it matters. In future posts, I’ll discuss its origins and what to do about it.

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